This is the second story in a three-part series about the relationship between education and mental health. You can read the first installment about mental health in early education here.

I love teaching writing; it’s where revelations happen, where children plumb the dark corners, nudge the sleeping dogs, and work out solutions to their most convoluted dilemmas. As much as I adore reading student work, I still get a little nervous about what I’ll find there. Among the stories of what my teenage students did last summer and what they want to be when they grow up are the more emotionally loaded accounts: firsts (periods, kisses, or failures), transitions (moves, their parents’ divorces, or custody disputes), and departures (dropouts, graduations, or suicide attempts).

Over the years, my students have entrusted me with their most harrowing moments: psychotic hallucinations, sexual molestation, physical abuse, substance abuse, HIV exposures, and all sorts of self-injurious behavior ranging from cutting to starvation to trichotillomania. When students write about delicate and dangerous experiences, there are decisions to be made and judgments to be called. And yet, for much of my career, I have been horribly unprepared and have failed to secure the services my students needed as a result.

Teachers are often the first person children turn to when they are in crisis, and yet they are, as a profession, woefully unprepared to identify students’ mental-health issues and connect them with the services they need—even when those services are provided by schools. Aside from the obligatory professional-development session on mandatory reporting laws for child abuse and neglect we have to attend during new faculty orientation, teachers receive little or no education in evidence-based mental-health interventions. According to Darcy Gruttadaro, Director of Advocacy and Public Policy at the National Alliance on Mental Illness, “Most teachers are not trained about mental health in their formal education and degree programs, and yet an unidentified mental-health condition often interferes with a student’s ability to learn and reach their full academic potential.”

According to the National Institute of Mental Health, approximately one in five children currently have or will experience a severe mental disorder. For some disorders, such as anxiety, the rates are even higher. For people who do experience mental-health disorders, most experienced their first symptoms before young adulthood. Half of all people with mental disorders experienced the onset of symptoms by age of 14; 75 percent by age 24. Half of these students will drop out of school. As suicide is the second-leading cause of death among adolescents and young adults, lack of appropriate mental-health interventions and treatment can mean the difference between life and death. Given the amount of time children spend at school, teachers are likely be the ones to identify and refer children for mental-health services. For children fortunate enough to be identified and given access to those services, treatment will mostly likely take place at school, as schools serve as the primary providers of mental services for children in this country.

However, all the mental-health services in the world won’t help if teachers don’t understand the nature of the services available in school and can’t identify the students in need of intervention.

In 2011, researchers at the University of Missouri looked at whether teachers understood the 10 evidence-based mental-health interventions or resources their schools employed. The results were disheartening, to say the least. While two-thirds of the surveyed teachers held graduate degrees, and the remaining third had earned undergraduate degrees, more than 80 percent had never heard of some of the interventions or strategies their own school utilized. Half of the teachers surveyed did not know if their schools provided functional behavioral assessment or intervention planning at all. Given that the response rate for this study was only 50 percent—and it’s likely that teachers with a heightened interest in student mental health would be more likely to respond to the survey—these results probably overstate teachers’ understanding of the tools their own school districts use to support students’ mental and emotional health.

As an increasing number of schools roll out evidence-based mental-health programs such as Positive Behavioral Interventions and Supports (PBIS), teaching that promotes appropriate student behavior by proactively defining, teaching, and supporting positive student conduct, and Trauma-Sensitive Schools, programs aimed at reducing the effects of trauma on children’s emotional and academic well-being, educators need to be at least minimally conversant in the terminology, methods, and thinking behind these strategies. These programs provide strategies that can be highly effective, but only if the teachers tasked with implementing them are sufficiently trained in the basics of mental-health interventions and treatment.

Teachers routinely receive first-aid training in CPR, EpiPen use, and safe body fluid cleanup, but it’s rare for schools to offer training in mental health, said Todd Giszack, Academic Dean of Fork Union Military Academy in Fork Union, Virginia. Recognizing that schools are responsible for their students’ mental, as well as physical health, Fork Union Military Academy designed and implemented its own curriculum with the help of two mental-health professionals, and now offers eight-hour certification programs in Mental Health First Aid. “It has taken two years, but nearly all of our faculty and staff has become certified in Mental Health First Aid. This has allowed our school community to become familiar with trends and warning signs associated with adolescent emotional and mental health” Giszack said.

Dr. Michael Hollander, Assistant Professor in Psychology at Harvard Medical School and director of Training and Consultations on the 3East Dialectical Behavioral Therapy program at McLean Hospital in Belmont, Massachusetts, urges teachers to use caution when intervening in students’ mental-health crises. “In my experience, teacher response tends to be bi-modal; either they get solicitous, over-involved, and in over their head, or they mistake mental health issues for behavioral problems that require in-class discipline.”

Programs such as NAMI’s Parents and Teachers as Allies presentation are beneficial, Dr. Hollander said, because they help teachers understand both the benefits and limitations of in-class interventions. Despite his worries about teacher-facilitated mental health interventions, he’s grateful for the trend toward a greater understanding of students’ mental health. “We have arrived at a place where we finally understand that teaching is not just about educating someone’s rational mind, but also educating their heart,” he said.

Children with untreated mental-health issues can get by. They can limp along toward adulthood until an inevitable, eventual mental-health crisis lands them in the hospital, in jail, or even at an inpatient drug and alcohol rehabilitation facility for adolescents, where I teach. But by then, a lot of damage has been done to their young minds and hearts—damage that could have been prevented if they had received support when their symptoms first appeared.

As I read their essays about crippling childhood anxiety, alcoholic parents, and/or domestic violence, I can’t help but mourn for all the lost opportunities and squandered potential that was wasted on the way.

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